In this study, reports were reviewed from nationally representative surveys in African malaria-endemic countries from 2006 through 2008 to understand how reported intervention coverage rates reflect access by the most at-risk populations. These included 27 demographic and health surveys (DHSs), multiple indicator cluster Surveys (MICSs), and malaria indicator surveys (MISs) during this interval with data on household intervention coverage by urban or rural setting, wealth quintile, and sex. Household ownership of insecticide-treated mosquito nets (ITNs) varied from 5% to greater than 60%, and was equitable by urban/rural and wealth quintile status among 13 (52%) of 25 countries. Malaria treatment rates for febrile children under five years of age varied from less than 10% to greater than 70%, and while equitable coverage was achieved in 8 (30%) of 27 countries, rates were generally higher in urban and richest quintile households. Recent efforts to scale up malaria intervention coverage have achieved equity in some countries (especially with ITNs), but delivery methods in other countries are not addressing the most at-risk populations.
Equitable health services
This study in Western Cape South Africa shows that while immunisation coverage indicates that a lot of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. The coverage will need to be sustainably improved before introducing rubella vaccine as part of the EPI schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focussed.
Examining vulnerabilities within the world’s current public healthcare systems, the authors of this study propose borrowing two tools from the fields of engineering and design: A systems approach, as advocated by Reason in 1990, and a user-centered design, as advocated by Norman and Draper. Both approaches are human-centered in that they consider common patterns of human behaviour when analysing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in relation to health care systems. It argues that maintaining a human-centered orientation in clinical care, research, training and governance is critical to the evolution of an effective and sustainable health care system.
WHO Assistant Director General for health systems, Carissa Etienne, stressed the need for evidence, information and research to make cost-effective health policies in developing countries. Specifically, she called for a systematic review of all research on primary health care since Alma Ata to provide real evidence on what works and fails, as well as for research on Community health workers – all against a measure of health outcomes.
The first-ever ministerial conference on immunization in Africa was held in February in Addis Ababa. According to the author it presents the perfect opportunity to acknowledge the benefits of vaccine programs, celebrate the successes on the continent, look seriously at what needs to be done to make sure all children get the vaccines they need, and then commit to making that happen. A new study from the Johns Hopkins Bloomberg School of Public Health estimates that between 2011 and 2020, the majority of countries in Africa will collectively see a net economic benefit of $224 billion by investing in immunization programs. The study also found that, in 94 low- and middle-income countries around the world, for every dollar invested in vaccines during the decade, there will be an estimated return of 16 times the costs, taking into account treatment costs and productivity losses. Unfortunately, at the current rate of progress, we are not on track to meet the ultimate goal of reaching all children with vaccines. Right now, one in five African children still do not receive the vaccinations they need. Of the 10 countries around the world with the most unvaccinated children, five are African: the Democratic Republic of the Congo, Ethiopia, Nigeria, South Africa and Uganda.
In December, the IWG hosted an event with health professionals with experience in different fields to better understand leadership in health systems, and consolidated the reflections from the discussions. The discussion raised several key features, including: Investing in gender, racial, and geographic equity among global health leaders and health activists; improving teamwork and multidisciplinary collaborations between individuals and communities of diverse skills, capabilities and backgrounds; networking across health leaders and communities and promoting local ownership and leadership. The session also pointed to the importance for the success of public health interventions and initiatives that those affected and implementing them be at the centre of the design and interactions.
The study explored the frequency and associated factors of disrespect and abuse in four rural health centres in Ethiopia. The experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction and exit interview at time of discharge. Incidence of disrespect and abuse were observed in each facility, with failure to ask woman for preferred birth position most commonly observed. During exit interviews, 21% of respondents reported at least one occurrence of disrespect and abuse. Bivariate models using client characteristics and index birth experience showed that women’s reporting of disrespect and abuse was significantly associated with childbirth complications, weekend delivery and no previous delivery at the facility. Facility-level fixed-effect models found that experience of complications and weekend delivery remained significantly and most strongly associated with self-reported disrespect and abuse. The results suggest that addressing disrespect and abuse in health centres in Ethiopia will require a sustained effort to improve infrastructure, support the health workforce in rural settings, enforce professional standards and target interventions to improve women’s experiences as part of quality of care initiatives.
Public health facilities in Africa currently stock only about half of a core set of essential medicines, such as those used to treat malaria, pneumonia, diarrhoea, HIV, TB, diabetes and hypertension, which are among the highest causes of death in Africa. The Stop the Stock-outs Campaign is calling on governments and health departments to end stock-outs by providing financial and operational autonomy to the national medicines procurement and supply agency, giving representation of civil society on the board of the agency, ending corruption in the medicine supply chain to stop theft and diversion of essential medicines, providing a dedicated budget line for essential medicines, living up to commitments to spend 15% of national budgets on health care and providing free essential medicines at all public health institutions.
The Joint Learning Network (JLN) for Universal Health Coverage held its third workshop, “Expanding Coverage to the Informal Sector,” in Mombasa, Kenya on 6-10 June 2011. Over 65 country level policymakers and practitioners from developing countries, including Kenya, Nigeria and Rwanda, participated in four days of discussions and problem-solving on issues related to providing health coverage to poor and informal sector populations. Participants also exchanged ideas about how to improve operations. Topics included partnerships with community organisations for targeting and enrollment, new information communications technologies for premium payment and enrollment verification, and innovative models to ensure access to health services, such as health camps and partnerships with social franchise networks. Participants also discussed how to deal with multiple schemes in moving toward universal coverage, looking at the case study of Kenya’s National Hospital Insurance Fund and the path to universal health coverage.
This article reviews the progress made on a three-year tuberculosis (TB)/HIV plan implemented in Malawi between 2003 and 2005. The objectives of the plan were to scale up HIV testing among TB patients and, for HIV-positive TB patients, to provide cotrimoxazole preventive therapy (which provides protection against bacterial infections including pneumonia) and facilitate access to antiretroviral (ARV) treatment. The paper finds that the proportion of TB patients tested for HIV increased from 15 per cent in 2003 to 47 per cent in 2005. During this time, most HIV-positive TB patients started cotrimoxazole preventative therapy.